Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion

Abstract

IntroductionCerebral collateral circulation has a central role in ischemic stroke pathophysiology, and it is considered to correlate with infarct size, the success of reperfusion therapies, and clinical outcomes. Our aim was to study the factors influencing the development of collaterals in patients with acute ischemic stroke eligible for endovascular treatment.Materials and methodsWe enrolled patients with acute ischemic stroke and large vessel occlusion of anterior circulation potentially eligible for endovascular treatment. Included patients performed multiphase CT angiography to assess collaterals that were graded by the Menon Grading Score. We investigated the associations between clinical factors and collaterals and tested independent associations with logistic (good vs. poor collaterals) and ordinal (collateral grade grouped, Menon 0–2, 3, 4–5) regression analysis adjusting for age, sex, stroke severity, and onset to CT time (OCTT).ResultsWe included 520 patients, the mean age was 75 (±13.6) years, 215 (41%) were men, and the median (IQR) NIHSS was 17 (11–22). Good collaterals were present in 323 (62%) patients and were associated with lower NIHSS (median 16 vs. 18; p < 0.001) and left hemisphere involvement (60% vs. 45%; p < 0.001), whereas previous stroke/TIA was more frequent in patients with poor collaterals (17 vs. 26%; p = 0.014). These results were confirmed in both logistic and ordinal regression analyses where good collaterals were associated with lower NIHSS (OR = 0.94; 95% CI = 0.91–0.96; cOR = 0.95; 95% CI = 0.92–0.97, respectively) and left hemisphere stroke (OR = 2.24; 95% CI = 1.52–3.28; cOR = 2.11; 95% CI = 1.46–3.05, respectively), while previous stroke/TIA was associated with poor collaterals (OR = 0.57; 95% CI = 0.36–0.90; cOR = 0.61; 95% CI = 0.40–0.94, respectively). Vascular risk factors, demographics, and pre-stroke treatments did not influence the collateral score.DiscussionThe results of our study suggest that risk factors and demographics do not influence the development of collateral circles, except for a negative relation with previous ischemic events. We confirm an already reported observation of a possible protective effect of collaterals on tissue damage assuming NIHSS as its surrogate. The association between left hemispheric stroke and better collaterals deserves to be further explored. Further efforts are needed to identify the factors that favor the development of collaterals.

Communicating Arteries and Leptomeningeal Collaterals: A Synergistic but Independent Effect on Patient Outcomes after Stroke

“…Studies have shown that patients with higher collateral activation have lower NIHSS values on admission [ 41 , 42 ]. This is in accordance with our study, explaining that higher NIHSS reflects larger ischemic tissue volume [ 43 , 44 ], as confirmed in our results.…”

Predictors of mTICI 2c/3 over 2b in patients successfully recanalized with mechanical thrombectomy

“…First, patients who present with a more severe stroke may have a larger and/or more invasive blood clot that is more challenging to remove, resulting in less complete recanalization of the occluded vessel(s). 30 , 31 Second, higher admission NIHSS is associated with worse collateral status, 32 , 33 , 34 which in turn is associated with less successful reperfusion following endovascular treatment. 35 , 36 Third, patients with more severe stroke symptoms are more likely to already have extensive and/or irreversible ischemic brain damage than those with milder symptoms, whether due to the severity of the clot or a delay in their evaluation, limiting the amount of reperfusion that can be achieved through MT.…”

The Compensation Index Is Better Associated with DSA ASITN Collateral Score Compared to the Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio

“…Collateral status (CS) is an excellent biomarker associated with ischemic core growth and success of reperfusion in patients with anterior circulation acute ischemic stroke caused by large vessel occlusion (AIS-LVO) [1][2][3][4][5].…”